Predictors of nurses' intention to accept COVID-19 vaccination: A cross-sectional study in five European countries

Understanding the impact of chronic diseases on COVID-19 vaccine hesitancy using propensity score matching: Internet-based cross-sectional study

AIMS AND OBJECTIVES

To investigate whether chronic diseases are associated with higher COVID-19 vaccine hesitancy and explore factors that influence COVID-19 vaccine hesitancy in patients with chronic diseases.

BACKGROUND

Vaccine hesitancy has been acknowledged as one of the greatest hazards to public health. However, little information is available about COVID-19 vaccine hesitancy among patients with chronic diseases who may be more susceptible to COVID-19 infection, severe disease or death.

METHODS

From 6 to 9 August 2021, we performed an internet-based cross-sectional survey with 22,954 participants (14.78% participants with chronic diseases). Propensity score matching with 1:1 nearest neighbourhood was used to reduce confounding factors between patients with chronic diseases and the general population. Using a multivariable logistic regression model, the factors impacting COVID-19 vaccine hesitancy were identified among patients with chronic diseases.

RESULTS

Both before and after propensity score matching, patients with chronic diseases had higher COVID-19 vaccine hesitancy than the general population. In addition, self-reported poor health, multiple chronic diseases, lower sociodemographic backgrounds and lower trust in nurses and doctors were associated with COVID-19 vaccine hesitancy among patients with chronic diseases.

CONCLUSIONS

Patients with chronic diseases were more hesitant about the COVID-19 vaccine. Nurses should focus on patients with chronic diseases with poor health conditions, low socioeconomic backgrounds and low trust in the healthcare system.

RELEVANCE TO CLINICAL PRACTICE

Clinical nurses are recommended to not only pay more attention to the health status and sociodemographic characteristics of patients with chronic diseases but also build trust between nurses and patients by improving service levels and professional capabilities in clinical practice.

PATIENT OR PUBLIC CONTRIBUTION

Patients or the public were not involved in setting the research question, the outcome measures, or the design or implementation of the study. However, all participants were invited to complete the digital informed consent and questionnaires.

Nurses' COVID-19-related fear and anxiety and their attitudes to the COVID-19 vaccine: A descriptive and correlational study

BACKGROUND

The novel coronavirus disease 2019 has caused psychological distress such as anxiety and fear among nurses worldwide. Nurses are a creditable source of vaccine-related information and have a primary role in building confidence regarding vaccines.

AIM

The present study was designed to investigate the fear and anxiety of nurses regarding novel coronavirus disease 2019 (COVID-19) and their attitudes towards the COVID-19 vaccine. The predictors of fear, anxiety and attitudes towards the vaccine were also investigated.

METHODS

A descriptive and correlational design was used. The study was conducted in three public hospitals from different parts of the Turkey, and 405 nurses from the three hospitals were recruited by stratified sampling.

RESULTS

Anxiety and negative attitudes towards the vaccine were positively related to fear of COVID-19. Age and fear were also positively associated with anxiety related to COVID-19. Nurses who had received the vaccine and those who were fearful had a positive attitude towards the vaccine.

CONCLUSION

Psychosocial support programmes should be implemented to improve psychological resilience and coping strategies in nurses and organized education programmes are needed to increase positive attitudes towards vaccination.

Factors Influencing COVID-19 Vaccination among Primary Healthcare Nurses in the Pandemic and Post-Pandemic Period: Cross-Sectional Study

The decision to vaccinate against COVID-19 is primarily a personal choice influenced by numerous factors. Vaccine acceptance and a positive attitude towards vaccination among nurses have an impact on patients' willingness to vaccinate. To assess COVID-19 vaccination coverage among primary healthcare nurses and to associate socio-demographic factors, comorbidity, self-rated health, and unhealthy lifestyle with the decision to be vaccinated, we conducted an online cross-sectional study from March to May 2023 using a self-administrated questionnaire. Probability sampling was used to select 32 health centers and nurses were invited via email. Among the 560 participants who completed survey, 78.3% and 50.8% received the primary two-dose course and at least one booster dose of COVID-19 vaccine, respectively. Primary care nurses who were ≥41 years of age, physically less active, and those who were overweight opted statistically significantly more often for the primary vaccination scheme (p = 0.00, 0.015 and 0.017, respectively). Education and the living environments of primary care nurses did not significantly influence the decision to receive two primary COVID-19 doses. Likewise, good self-rated health and comorbidity did not contribute significantly to the vaccination decision. Nurses that were vaccinated with booster doses were significantly more often overweight (p = 0.034) and ≥41 year of age (p = 0.000).

Nurses' attitudes towards COVID-19 vaccines: A qualitative study (PROACTIVE-study)

AIM

To explore the attitudes of healthcare workers towards COVID-19 vaccines.

DESIGN

A qualitative descriptive design was used.

METHODS

Five focus groups were conducted between October and November 2021, with a total of 30 nurses from different contexts in Northern Italy. Thematic analysis was used to analyse the transcripts.

RESULTS

Three main themes were identified: 'favourable', 'unsure' and 'contrary to' COVID-19 vaccines. The favourable position was underpinned by trust in science, research and vaccination; protection for themselves, their families, patients and the population; duty as professionals; necessity to set an example for others. Participants who were unsure had doubts about the composition, safety and efficacy of the vaccine and were sometimes afraid that media provided incomplete information. The main reason why nurses were against was the feeling that being forced to vaccinate perceived as blackmail. Favourable or unsure nurses struggled to deal with those who were against and developed a series of emotions that ranged from respect and attempt to rationalize, to frustration and defeat.

CONCLUSIONS

Identifying the areas of hesitation is essential to understand what affects the choices of acceptance, delay or refusal of vaccination. The issues that emerged regarding proper communication within the vaccination campaign highlights the key importance of adequate vaccination strategies.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

Understanding attitudes towards vaccine and related motivations among healthcare workers could help develop more specific and targeted vaccination campaigns that can ensure proper vaccination coverage rates and avoid hesitancy or refusal.

IMPACT

Healthcare workers experiences of COVID-19 vaccines, their views and know how they feel during COVID-19 vaccinations. Healthcare workers had three different positions in COVID-19 vaccination. This research will guide and target future vaccination campaigns.

REPORTING METHOD

The study is reported using the Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Vaccinating without complete willingness against COVID-19: Personal and social aspects of Israeli nursing students and faculty members

Soon after the coronavirus disease 2019 (COVID-19) pandemic outbreak, it became clear that vaccination will be the most useful tool to combat the disease. Despite the apparent safety and efficacy of the developed anti-COVID-19 vaccines, relatively high percentages of the population worldwide refused to get vaccinated, including many health workers and health students. The present cross-sectional study examined the motives, attitudes, and personal characteristics of those who did not get vaccinated against COVID-19 or vaccinated without complete willingness among nursing students and nursing faculty members in Israel (n = 472). Results show that the vast majority of the study participants (97%) received at least one dose of the anti-COVID-19 vaccine. Nearly 37% of the participants indicated that they received the vaccine without complete willingness. As compared to faculty members, nursing students reported lower trust in the efficacy of the vaccine, perceived the COVID-19 pandemic as a health threat to a lesser extent, exhibited lower institutional and personal trust, and had higher levels of posttraumatic stress disorder symptoms. Non-Jewish participants were at risk of vaccinating without complete willingness. These findings underscore the need for developing evidence-based strategies to promote the safety and efficacy of the anti-COVID-19 vaccines in nursing schools.

Risk Perceptions Regarding COVID-19 and Compliance with Protective Measures of Midwifery and Nursing Senior Students

OBJECTIVE

This study aims to examine the risk perceptions of midwifery and nursing senior students regarding COVID-19 and compliance with vaccination and protective measures.

METHOD

This cross-sectional study was conducted in two academic years on senior midwifery and nursing students (n = 358). In the present study, the descriptive characteristics of the students and the COVID-19 risk perception scale were used.

RESULTS

The students' COVID-19 Risk Perception Scale scores were at a moderate level and a similar level in both years of this study. More than 80% of the students were fully vaccinated, and the family history of COVID-19 was positive in approximately half of them. In the second year of the pandemic, they paid less attention to social distance and avoidance of being indoors.

CONCLUSION

Although the COVID-19 risk perceptions of future health professional students remained at a similar level during the examined period, it was found that in the second year of the pandemic, they started to get used to the process and paid less attention to social protective measures.

Surname order and revaccination intentions during the COVID-19 pandemic

Teachers in Japanese schools employ alphabetical surname lists that call students sooner, with surnames appearing early on these lists. We conducted Internet surveys nearly every month from March 2020 to September 2022 with the same participants, wherein we asked participants where the alphabetical columns of their childhood and adult surnames were located. We aimed to identify how surname order is important for the formation of noncognitive skills. During the data collection period, the COVID-19 vaccines became available; Japanese people could receive their third dose starting in December 2021. The 19th wave of the survey was conducted in January 2022. Therefore, to examine how a surname's alphabetical order could influence intention to revaccinate, we used a subsample of data from December 2021 to September 2022. The major findings were as follows. Women with early surnames had an approximately 4% stronger likelihood of having such intentions than men with early surnames. Early name order was more strongly correlated with revaccination intention among women than among men. The surname effect for women was larger when a mixed-gender list was used compared with when it was not used. This effect was only observed for childhood surnames and not for adult surnames.

Working through a pandemic: The mediating effect of nurses' health on the relationship between working conditions and turnover intent

AIM

While research has demonstrated that nurses' health and working conditions are important predictors of turnover in COVID-19, the relationship between these factors is not well understood. Our study investigated the mechanism through which working conditions and nurses' physical and mental health could impact intent to leave the nursing profession.

DESIGN

Secondary data from a cross-sectional survey of 3478 nurses in British Columbia administered in May 2021 were analysed using structural equation modelling.

METHODS

Two models were assessed utilizing workplace conditions as the predictor, nurses' health as the mediator, and reported turnover intent (Model 1), and anticipated time to turnover (Model 2) as the outcomes.

RESULTS

Nurses' health partially mediated the relationship between working conditions and turnover intent, where poorer workplace conditions were directly and indirectly associated with greater likelihood of leaving the profession. Nurses' health fully mediated the relationship between working conditions and nurses' anticipated time to turnover, after controlling for age. The findings from this study underscore the importance of enhancing working conditions and improving nurses' mental health and safety on the job.

PATIENT OR PUBLIC CONTRIBUTION

The British Columbia Nurses' Union provided the data for this study; survey data from 3478 nurses were utilized in our study.

Predictors of second COVID-19 booster dose or new COVID-19 vaccine hesitancy among nurses: A cross-sectional study

AIMS AND OBJECTIVES

To assess the levels of second COVID-19 booster dose/new COVID-19 vaccine hesitancy among nurses and explore the potential predictors of vaccine hesitancy.

BACKGROUND

COVID-19 full vaccination seems to be highly effective against highly contagious variants of SARS-CoV-2. Healthcare workers are at high-risk group since they have experienced high levels of COVID-19-associated morbidity and mortality.

DESIGN

An on-line cross-sectional study was carried out in Greece in May 2022, using a self-administered questionnaire.

METHODS

The study population included nurses in healthcare services who were fully vaccinated against COVID-19 at the time of study. We considered socio-demographic characteristics, COVID-19-related variables, and attitudes toward COVID-19 vaccination and pandemic as potential predictors of vaccine hesitancy. We applied the STROBE checklist in our study.

RESULTS

Among 795 nurses, 30.9% were hesitant toward a second booster dose or a new COVID-19 vaccine. Independent predictors of hesitancy included lower educational level, absence of a chronic condition, good/very good self-perceived physical health, lack of flu vaccination during 2021, front-line nurses that provided healthcare to COVID-19 patients, nurses that had not been diagnosed with COVID-19 and nurses that had at least one relative/friend that has died from COVID-19. Moreover, increased compliance with hygiene measures, increased fear of a second booster dose/new COVID-19 vaccine and decreased trust in COVID-19 vaccination were associated with increased hesitancy.

CONCLUSIONS

Our study shows that a significant percentage of nurses are hesitant toward a second booster dose/new COVID-19 vaccine. This initial hesitancy could be a barrier to efforts to control the COVID-19 pandemic.

RELEVANCE TO CLINICAL PRACTICE

Nurses' role during the COVID-19 pandemic is essential since they are the front-line healthcare workers empowering the public with their passion and empathy. There is a need to communicate COVID-19 vaccine science in a way that is accessible to nurses in order to decrease COVID-19 vaccine hesitancy.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Individual and Work-Related Characteristics Associated with COVID-19 Vaccination Status among Ohio Nurses

Uptake of the COVID-19 vaccine by nurses lags behind that of other health care professionals with minimal empirical evidence to understand this phenomenon. In this secondary analysis, we examined nurses' individual and work-related characteristics and their association with COVID-19 vaccination status. Alumni of three Ohio nursing colleges and members of a professional organization were invited to complete questionnaires from June through August 2021. Logistic regression models were used to evaluate associations between nurse characteristics and vaccination status. Among 844 respondents, 754 (80.30%) had received at least one dose of the vaccine. Older age, having a bachelor's degree or higher, and working in critical care were associated with vaccination. Providing direct care for COVID-19 patients in the last 7 days and a higher perception of one's work being affected by COVID-19 were significantly associated with being vaccinated, whereas prior COVID-19 infection was inversely associated with vaccination status. Our findings suggest that COVID-19 vaccine uptake among nurses is influenced by a host of factors related to virus knowledge, beliefs, and risk perceptions. Awareness of these factors can aid the development of interventions to increase nurses' acceptance of vaccines.

Do psychological distress and digital sports influence the willingness to take the vaccine and precautionary saving? Empirical evidence from Shanghai

Aim

The COVID-19 epidemic has caused risk and uncertainty. This study answers whether and how psychological distress and digital sports influence willingness to take the vaccine and precautionary savings.

Subject and methods

We conducted a cross-sectional study with an online survey sample of 1016 Shanghai residents who live and work there and are aged between 16-60. All of them experienced the COVID-19 lockdown in Shanghai. We used logistic regressions to examine the relationships between the variables of interest.

Results

Three findings were demonstrated. First, psychologically distressed individuals are less inclined to take the vaccine. Second, those engaged in fitness activities via digital media platforms are more willing to get vaccinated. Third, psychologically distressed individuals and digital video-based physical exercisers are more likely to precautionary save.

Conclusions

This study contributes to the literature by documenting how people changed their life from the perspective of finance and health during the lockdown and providing practical implications.

Factors influencing attitudes toward vaccine safety and vaccine effectiveness amongst UK healthcare professionals prior to and at the time of COVID-19 vaccine rollout: Insights from the CoPE-HCP cohort study

Given the potential for nosocomial outbreaks, we must understand factors associated with negative vaccine attitudes amongst healthcare professionals (HCPs) before the rollout of a newly developed vaccine in a pandemic setting. The aim of this prospective cohort study was to study the impact of preexisting and prevailing mental health on United Kingdom HCPs' attitudes towards a newly developed COVID-19 vaccine. Two online surveys were distributed: first during vaccine development (July-September, 2020) and second during nationwide vaccine rollout (December 2020-March 2021). Mental health (PHQ-9 for depression; GAD-7 for anxiety) was assessed in both surveys. Negative attitude regarding vaccine safety and vaccine effectiveness was assessed at vaccine rollout. A series of logistic regression models were developed relating mental health (preexisting during vaccine development, ongoing and new-onset during rollout, and changes in symptom severity) to negative vaccine attitudes. In 634 HCPs, the presence of depression and/or anxiety during vaccine development was associated with elevated negative attitude towards vaccine safety (adj. OR 1.74 [95% CI 1.10-2.75], p = .02), but not vaccine effectiveness (1.13 [0.77-1.66], p = .53) at rollout. This was independent of other characteristics: age, ethnicity, professional role, and history of contracting COVID-19. Ongoing depression and/or anxiety (1.72 [1.10-2.69], p = .02) was associated with elevated negative attitude regarding vaccine effectiveness, but not vaccine safety. Worsened combined symptom scores over time were associated with elevated negative vaccine effectiveness attitudes (1.03 [1.00-1.05], p < .05), but not vaccine safety. Overall, adverse mental health can impact on HCPs' attitudes towards a newly developed vaccine. Further work is required to understand how this translates to vaccine uptake.

Determinants of Acceptance of COVID-19 Vaccination in Healthcare and Public Health Professionals: A Review

Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational diseases, and indirectly protect their patients and communities. However, studies increasingly highlight that HCWs can be vaccine hesitant. This review aims to analyze HCWs' and public health professionals' sentiments toward COVID-19 (Coronavirus Disease 2019) vaccination and determinants across different countries. A search strategy was conducted in PubMed using keywords such as "COVID-19", "sentiment/acceptance", "healthcare workers", "vaccine hesitancy", and "influenza". A total of 56 articles were selected for in-depth analyses. The highest COVID-19 vaccination uptake was found in an Italian study (98.9%), and the lowest in Cyprus (30%). Older age, male gender, the medical profession, higher education level, presence of comorbidities, and previous influenza vaccination were associated with vaccine acceptance. Factors for low acceptance were perceived side effects of the vaccine, perceived lack of effectiveness and efficacy, and lack of information and knowledge. Factors for acceptance were knowledge, confidence in the vaccine, government, and health authorities, and increased perception of fear and susceptibility. All studies focused on healthcare providers; no studies focusing on public health professionals' sentiments could be found, indicating a gap in research that needs to be addressed. Interventions must be implemented with vaccination campaigns to improve COVID-19 vaccine acceptance.

Social Support Mediates the Relationship between COVID-19-Related Burnout and Booster Vaccination Willingness among Fully Vaccinated Nurses

COVID-19 booster doses for high-risk groups such as nurses are necessary to reduce the impacts of the pandemic and promote public health. We examined the relationship between COVID-19-related burnout and booster vaccination willingness among nurses, and we assessed whether social support can buffer this relationship. We conducted a cross-sectional study with 963 fully vaccinated nurses working in healthcare settings in Greece. We used the multidimensional scale of perceived social support to measure social support and the COVID-19 burnout scale to measure COVID-19-related burnout. We measured vaccination willingness with a scale from 0 (extremely unlikely to take a booster dose) to 10 (extremely likely). Among nurses, 37.1% reported being very likely to be vaccinated, 34.4% reported being uncertain about their likelihood of vaccination, and 28.6% reported being very unlikely to be vaccinated with a booster dose. We found that COVID-19-related burnout reduced vaccination willingness, while social support functioned as a partial mediator of this relationship. In conclusion, nurses who experienced burnout were less likely to accept a booster dose. Furthermore, increasing nurses' social support reduced the negative effects of burnout, resulting in improved booster vaccination willingness. Immunization awareness programs should be implemented in order to address nurses' concerns and support booster doses.

Differences between COVID-19-vaccinated and unvaccinated participants from Croatia

AIM

To compare Croatian participants vaccinated against coronavirus disease 2019 (COVID-19) and unvaccinated participants in terms of socio-demographic, personal, social, and COVID-19-related variables.

METHODS

From August till December 2021, 721 (465 vaccinated and 256 unvaccinated) participants completed an online survey about socio-demographic (age, sex income, education, marital status), personal (well-being indicators, personality measures and health), social (trust in experts, trust in government), and COVID-19-related characteristics (fear of COVID-19, history of COVID-19 infection). Differences between the groups were assessed with discriminant analysis.

RESULTS

The variables that best discriminated between vaccinated and unvaccinated participants were higher trust in experts, no history of COVID-19 infection, older age, higher fear of COVID-19, and intellect. Conclusion The study points to the importance of trust in experts in the promotion of COVID-19 vaccine.

Differences between COVID-19-vaccinated and unvaccinated participants from Croatia

AIM

To compare Croatian participants vaccinated against coronavirus disease 2019 (COVID-19) and unvaccinated participants in terms of socio-demographic, personal, social, and COVID-19-related variables.

METHODS

From August till December 2021, 721 (465 vaccinated and 256 unvaccinated) participants completed an online survey about socio-demographic (age, sex income, education, marital status), personal (well-being indicators, personality measures and health), social (trust in experts, trust in government), and COVID-19-related characteristics (fear of COVID-19, history of COVID-19 infection). Differences between the groups were assessed with discriminant analysis.

RESULTS

The variables that best discriminated between vaccinated and unvaccinated participants were higher trust in experts, no history of COVID-19 infection, older age, higher fear of COVID-19, and intellect. Conclusion The study points to the importance of trust in experts in the promotion of COVID-19 vaccine.

When the first vaccine arrived: An investigation of factors that influenced the intention of health care workers in the national health system of Greece to be vaccinated against the SARS COV-2 virus during the first trimester of vaccine arrival

BACKGROUND

COVID-19 vaccination started in Greece in the last days of December 2020. Health care workers (HCWs) of the public national health system (NHS) were on the frontline and they would be role models for all the citizens.

AIM

Investigation of the intention and hesitation of HCWs (doctors, nurses, and nursing assistants) of the NHS of Greece, regarding the vaccine against SARS COV-2 virus and the factors that affect them, during the first trimester of the availability of vaccines, in the country.

METHODS

A multicenter cross-sectional study was conducted in Greece among health professionals (n = 2484) of the NHS. Data were collected with the use of an online questionnaire through snowballing sampling.

RESULTS

Acceptance of a safe and effective COVID- 19 vaccines was higher among doctors (85.6%), followed by nurses (66.3%), and nursing assistants (64.1%). This study confirms pre-existing research on the interaction of gender, age, quality of personal information, educational level, training by the employer, and cognitive background regarding viruses and vaccines.

CONCLUSION

In conclusion, our study showed that once a vaccine was available, most HCWs were willing to be vaccinated. These findings could be used in the future to tailor communication and promotion campaigns, using anthropocentric strategies.

Addressing vaccine hesitancy and resistance for COVID-19 vaccines

The COVID-19 vaccine rollout has had various degrees of success in different countries. Achieving high levels of vaccine coverage is key to responding to and mitigating the impact of the pandemic on health and aged care systems and the community. In many countries, vaccine hesitancy, resistance, and refusal are emerging as significant barriers to immunisation uptake and the relaxation of policies that limit everyday life. Vaccine hesitancy/ resistance/ refusal is complex and multi-faceted. Individuals and groups have diverse and often multiple reasons for delaying or refusing vaccination. These reasons include: social determinants of health, convenience, ease of availability and access, health literacy understandability and clarity of information, judgements around risk versus benefit, notions of collective versus individual responsibility, trust or mistrust of authority or healthcare, and personal or group beliefs, customs, or ideologies. Published evidence suggests that targeting and adapting interventions to particular population groups, contexts, and specific reasons for vaccine hesitancy/ resistance may enhance the effectiveness of interventions. While evidence regarding the effectiveness of interventions to address vaccine hesitancy and improve uptake is limited and generally unable to underpin any specific strategy, multi-pronged interventions are promising. In many settings, mandating vaccination, particularly for those working in health or high risk/ transmission industries, has been implemented or debated by Governments, decision-makers, and health authorities. While mandatory vaccination is effective for seasonal influenza uptake amongst healthcare workers, this evidence may not be appropriately transferred to the context of COVID-19. Financial or other incentives for addressing vaccine hesitancy may have limited effectiveness with much evidence for benefit appearing to have been translated across from other public/preventive health issues such as smoking cessation. Multicomponent, dialogue-based (i.e., communication) interventions are effective in addressing vaccine hesitancy/resistance. Multicomponent interventions that encompasses the following might be effective: (i) targeting specific groups such as unvaccinated/under-vaccinated groups or healthcare workers, (ii) increasing vaccine knowledge and awareness, (iii) enhanced access and convenience of vaccination, (iv) mandating vaccination or implementing sanctions against non-vaccination, (v) engaging religious and community leaders, (vi) embedding new vaccine knowledge and evidence in routine health practices and procedures, and (vii) addressing mistrust and improving trust in healthcare providers and institutions via genuine engagement and dialogue. It is universally important that healthcare professionals and representative groups, as often highly trusted sources of health guidance, should be closely involved in policymaker and health authority decisions regarding the establishment and implementation of vaccine recommendations and interventions to address vaccine hesitancy.

Confidence in a Vaccine against COVID-19 among Registered Nurses in Barcelona, Spain across Two Time Periods

OBJECTIVE

To report the vaccine hesitancy (VH) for a vaccine against COVID-19 in registered nurses in Barcelona, with measurements taken at two stages, prior to the vaccination campaign and once 75% vaccination coverage had been reached.

METHODS

A self-completed online survey was administered in December 2020 and again in July 2021 through the College of Nurses of Barcelona. It measured the prevalence of VH against a government-approved vaccine recommended by their employer, their intention to be vaccinated, perceptions of disease risk and vaccine protection, attitudes and beliefs to vaccination and social norm. Bivariate analysis according to VH and application time are presented.

RESULTS

2430 valid responses were obtained in the first measurement and 2027 in the second. At both times, 86% were women and 69% worked mainly in the public sector. Prior to the vaccine availability, VH was 34.2%, decreasing to 17.9%. Risk perceptions were significantly lower in those with VH compared to non-VH, in all groups studied and at both times, while safety and efficacy perceptions increased in all groups, significantly less in VH. The greatest benefit of the COVID-19 vaccine is perceived by pharmaceutical companies. VH nurses perceived a more hesitant social environment.

CONCLUSION

As the vaccination was rolled out, VH in nurses declined, with time improving the confidence in the safety and efficacy of the vaccines. Risk perceptions also decreased over time, except for the perception of severity in HCW where it increased. Trust in institutions impacts trust in vaccines.

Prevalence and Predictors of COVID-19 Vaccination Acceptance among Greek Health Care Workers and Administrative Officers of Primary Health Care Centers: A Nationwide Study Indicating Aspects for a Role Model

Background: Τhe study aims to identify factors associated with COVID-19 vaccine acceptance and to investigate knowledge and perceptions of Primary Health Care Centers (PHCC) personnel, who acted as pioneers in the national COVID-19 vaccination strategy. Methods and Materials: A nationwide cross-sectional survey was conducted by distributing an online anonymous questionnaire comprising 25 questions during the first semester of 2021. Results: Approximately 85.3% of the 1136 respondents (response rate 28.4%) were vaccinated or intended to be. The acceptance of seasonal flu vaccine (aOR: 3.29, 95%CI: 2.08−5.20), correct COVID-19 vaccine knowledge (aOR: 8.37, 95%CI: 4.81−14.59) and lack of concern regarding vaccine novelty (aOR: 6.18, 95%CI: 3.91−9.77) were positively correlated with vaccine acceptance. Vaccinated respondents were more likely to be physicians (aOR: 2.29, 95%CI: 1.03−5.09) or administrative staff (aOR: 2.65, 95%CI: 1.18−5.97) compared to nursing stuff. Reasons for vaccine hesitancy included inadequate information (37.8%) and vaccine safety (31.9%). Vaccine acceptance was strongly correlated (Spearman’s correlation coefficient r = 0.991, p < 0.001) between PHCC personnel and the general population of each health district. Conclusions: COVID-19 vaccine acceptance among PHCC personnel in Greece was comparably high, but specific groups (nurses) were hesitant. As the survey’s target population could serve as a role model for the community, efforts should be made to improve COVID-19 vaccine acceptance.

How Implicit Attitudes toward Vaccination Affect Vaccine Hesitancy and Behaviour: Developing and Validating the V-IRAP

Vaccination is one of the most important ways of fighting infectious diseases, such as COVID-19. However, vaccine hesitancy and refusal can reduce adherence to vaccination campaigns, and therefore undermine their effectiveness. Although the scientific community has made great efforts to understand the psychological causes of vaccine hesitancy, studies on vaccine intention have usually relied on traditional detection techniques, such as questionnaires. Probing these constructs explicitly could be problematic due to defense mechanisms or social desirability. Thus, a measure capable of detecting implicit attitudes towards vaccination is needed. To achieve this aim, we designed and validated a new test called the Vaccine-IRAP, or V-IRAP, which is a modified version of the original Implicit Relational Assessment Procedure, or IRAP, task. The V-IRAP allows the unspoken reasons behind vaccine hesitancy to be investigated, and is able to distinguish between positive and negative beliefs on vaccination. The test was assessed in a sample of 151 participants. The V-IRAP showed good internal reliability and convergent validity, with meaningful correlational patterns with explicit measures. Moreover, it revealed incremental validity over such explicit measures. Lastly, the V-IRAP was able to shed light on the implicit attitudes involved in vaccine refusal, revealing negative attitudes relative to vaccine-related risks in non-vaccinated participants. Overall, these results support V-IRAP as a sensitive and reliable tool that could be used in future studies on implicit attitudes toward vaccination.

Physicians' Perspective on Vaccine-Hesitancy at the Beginning of Israel's COVID-19 Vaccination Campaign and Public's Perceptions of Physicians' Knowledge When Recommending the Vaccine to Their Patients: A Cross-Sectional Study

Because public healthcare workers (HCWs) are at the forefront of the battle against COVID-19, they must be able to provide vaccination information to their patients and respond to their anxieties and concerns. This research objectives were to (1) examine physicians' perceptions of how they received information about the Pfizer COVID-19 vaccine, their attitudes toward hesitant colleagues, and their own knowledge and self-efficacy in communicating information to their patients, and (2) to examine the public's perceptions of physicians' knowledge when recommending the COVID-19 vaccine to their patients. At the beginning of the vaccination campaign, a survey examined the attitudes of physicians in the Israeli public healthcare system (n = 295) regarding the Pfizer vaccine. In addition, the attitudes of a representative sample (n = 500) of the Israeli adult population (age 18+) were examined through interviews. Most of the participating physicians (81%) reported they had already been vaccinated or intended to be vaccinated. When asked about their reasons for vaccine hesitancy, 27% cited concerns about long-term side effects and doubts about the vaccine's effectiveness in preventing contagion. They cited system pressure and departmental norms as explanations for their eventual compliance. Moreover, they saw the system as less tolerant of hesitant physicians, while they themselves tend to be more tolerant. The results of the survey of the public showed that mostly young people (under 44) who tend to be critical believe that physicians do not have sufficient knowledge to make recommendations about the COVID-19 vaccine. The findings indicate that the health system should employ complete transparency in conveying the advantages and disadvantages of the COVID-19 vaccine to physicians. The system should be more tolerant of physicians' worries and concerns and grant legitimacy to their reservations and misgivings. Moreover, medical studies should reinforce physicians' immunological knowledge regarding vaccinations so they can help their patients make informed decisions.

COVID-19 Vaccine Refusal among Nurses Worldwide: Review of Trends and Predictors

COVID-19 vaccination hesitancy has become a major concern around the world. Recent reports have also highlighted COVID-19 vaccination hesitancy in healthcare workers. Despite media reports and scientific publications, little is known about the extent and predictors of COVID-19 vaccination refusal among nurses. Thus, the purpose of this study was to assess COVID-19 vaccine refusal rates among nurses globally and to explore the reasons for refusal and factors associated with the uptake of the vaccines. A scoping review of the published literature was conducted, and a final pool of 51 studies (n = 41,098 nurses) from 36 countries was included in this review. The overall pooled prevalence rate of COVID-19 vaccine refusal among 41,098 nurses worldwide was 20.7% (95% CI = 16.5-27%). The rates of vaccination refusal were higher from March 2020-December 2020 compared to the rates from January 2021-May 2021. The major reasons for COVID-19 vaccine refusal were concerns about vaccine safety, side effects, and efficacy; misinformation and lack of knowledge; and mistrust in experts, authorities, or pharmaceutical companies. The major factors associated with acceptance of the vaccines were: male sex, older age, and flu vaccination history. Evidence-based strategies should be implemented in healthcare systems worldwide to increase the uptake of COVID-19 vaccines among nurses to ensure their safety and the safety of their patients and community members.

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

Vaccine hesitancy is a challenge for the success and optimal implementation of COVID-19 immunization programs in the US. The objective of this study was to summarize multilevel determinants of COVID-19 vaccination intention in the US to inform future intervention opportunities. To this end, we conducted a rapid systematic review by searching published articles via PubMed published by October 5, 2021, following the PRISMA guidelines. One hundred and six articles were included. According to nationally representative studies, the overall COVID-19 acceptance rate ranges from 53.6% to 84.4%. Individual (demographics, health history, behaviors and health beliefs), interpersonal (having a close friend/family member impacted by COVID-19), healthcare and societal level factors (healthcare provider recommendations, source/credential of COVID-19 related information, and COVID-19 related conspiracy theories) all contributed to COVID-19 vaccine hesitancy in the US. This study demonstrates that the acceptance to COVID-19 vaccines is influenced by various factors, particularly the role of healthcare providers in enhancing public intent to vaccination. Potential interventions to mitigate people's concerns over the vaccines and address vaccine-related conspiracy/misinformation from social media are also critical to encourage vaccine uptake in the US.

General vaccination knowledge influences nurses’ and midwives’ COVID-19 vaccination intention in Cyprus: a nationwide cross-sectional study

This cross-sectional study was conducted during the period between 08 and 28 December 2020 to investigate the association of nurses’ and midwives’ level of vaccination knowledge and the COVID-19 vaccine acceptance for themselves during the COVID-19 pandemic era in Cyprus. Participants included registered nurses and midwives working in public or private service provision. Data collection was achieved using a self-administered questionnaire with questions on socio-demographic characteristics, questions assessing participants’ general vaccination knowledge, and questions related to COVID-19 vaccination. A total of 437 responders answered the survey, with 93% being nurses and 7% midwives. The results indicate that as the vaccination knowledge score increases (higher knowledge) the probability of accepting the COVID-19 vaccination increases too (OR = 1.30, 95% CI: 1.13–1.48). The association between vaccination knowledge and the intention to be vaccinated against COVID-19 remained statistically significant, even after adjusting for age and gender (OR = 1.28, 95% CI: 1.12–1.47), socioeconomic (OR = 1.29, 95% CI: 1.12–1.48), and demographic characteristics (OR = 1.29, 95% CI: 1.11–1.49). Also, as age increases, the probability of accepting the COVID-19 vaccination increases, while female respondents had a lower probability of accepting the COVID-19 vaccination than male respondents. This study demonstrated that COVID-19 vaccination acceptance is related to the vaccination knowledge of the nurses and midwives in Cyprus. Targeted vaccination campaigns are needed to improve nurses’ and midwives’ level of vaccination knowledge in order to achieve a better coverage among them, as well as to influence their patients’ ultimate positive vaccine decision.

Assessment of COVID-19 Fear in Five European Countries before Mass Vaccination and Key Predictors among Nurses and Nursing Students

Background: Levels of fear have increased since the COVID-19 pandemic outbreak. The absence of a safe and effective vaccine for mass-vaccination deteriorates this situation, which has a significant impact on mental health. This study aimed to assess the feelings of fear among nurses and nursing students in five European countries. Methods: A multicenter cross-sectional study was conducted in five European countries (Greece, Albania, Cyprus, Spain, and Kosovo) before the start of mass vaccination in Europe. Data collection was conducted in December 2020–January 2021 using an online questionnaire for nursing students and professional nurses. Fear of COVID-19 Scale (FCV-19S) was used for measuring levels of fear. IBM SPSS version 21.0 was used for statistical analysis. Results: The study population included 1135 nurses and 1920 nursing students from Kosovo (n = 1085), Spain (n = 663), Greece (n = 534), Albania (n = 529), and Cyprus (n = 244). According to multivariable analysis, females (OR = 2.53, 95% CI = 1.89–3.15), married (OR = 0.86, 95% CI = 0.24–1.48), nurses (OR = 0.87, 95% CI = 0.28–1.45) and those with a chronic disease (OR = 0.86, 95% CI = 0.11–1.62) were more fearful of COVID-19. Conclusions: It is important to decrease fear in the population of nurses who are at the frontlines of the pandemic. The provision of appropriate education and training activities for nurses and students to manage their stress levels is of high importance. Future studies should focus on levels of fear after the administration of several safe and effective vaccines worldwide.

Knowledge and attitudes toward vaccination among nurses and midwives in Cyprus: A cross-sectional study

PURPOSE

To assess the level of knowledge and attitudes of nurses and midwives in Cyprus toward vaccinations and provide new insights into the determinants that influence them.

METHODS

An online cross-sectional study was carried out during the period between December 08 and 28 2020. Participants included registered nurses and midwives working in public or private service provision. A self-administered questionnaire was used with questions about sociodemographic characteristics, questions assessing attitudes and beliefs toward vaccination, and participants' general vaccine knowledge.

FINDINGS

A total of 437 responders answered the survey, with 93% being nurses and 7% midwives. Around two-thirds (67.3%) of the participants had a high vaccination knowledge, while the remaining have moderate (30.7%), and low (2.1%), respectively. Most of the participants agreed that by vaccinating they protect themselves and those around them (80.5%) and that when most people are not vaccinated, epidemics can easily initiate (74%). Oppositely, many participants disagreed with vaccination and avoided it due to a fear of injections (95.4%) or the belief that it is better to get sick rather than be vaccinated (69.1%). Neutral attitudes toward vaccine-mediated side effects (43.1%) and vaccination safety (41.7%) were observed. Sociodemographic factors such as age, educational status, and work setting significantly affected the nurses' and midwives' knowledge and attitudes toward vaccination (p < 0.05).

CONCLUSIONS

The findings indicate that the overall vaccination knowledge of participants was high, however, gaps in vaccination knowledge were observed. Individuals who adopted a neutral stance toward vaccination can be prone to changes either toward positive or negative attitudes.

IMPLICATIONS FOR NURSING PRACTICE

The survey findings suggest implementing educational strategies and targeted interventions in clinical settings to enhance nurses' and midwives' vaccination knowledge and awareness.